| NPI | 1497216410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-45783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09976) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2022-07-12 |